Excluded from PFS
J2781 · PFS Q2 2024 · Historical
Status E is not separately payable under the PFS.
CMS RVU24BApril 1 – June 30, 2024
PFS status evidence
Inspect PFS status evidence
- Code
- J2781
- Release
- Q2 2024, revision 1
- Result
- Excluded from PFS
Citations
-
Shows this code’s PFS status (E). Result: Excluded from PFS.
Physician relative value file (PPRRVU)CMS RVU24BApril 1 – June 30, 2024
This PFS record alone does not establish a $0 allowance or a coverage determination. Any amount from another schedule needs its own evidence.
PPRRVU24_APR.csv row 3,653 in rvu24b-updated-03-18-2024.zip
In the CMS file
Loading rows 3,651–3,655 of PPRRVU24_APR.csv…
Download rvu24b-updated-03-18-2024.zip from CMS File fingerprint
9acf98f4d515fb61037a7404940c363a795b0209d9c64268dd8e5962fb9e4a91
HCPCS J2781 has no published national rate. It carries status E (excluded) in the Q2 2024 release. A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. The blank amount means unpriced, not $0.
Why is there no national PFS amount for J2781?
Its status indicator is E (excluded). A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. Status E is not separately payable under the PFS.
About this code
Inj, pegcetacoplan, 1mg
Which billing rules and modifiers apply? Copy link
CMS's surgical and split-billing indicators don't adjust J2781's amount.
Global surgery period XXX (does not apply).
Why would a Medicare claim for J2781 be denied or paid less?
These come from CMS indicators on this page, not general billing advice.
- Its status indicator is E (excluded)—A regulation removes this code from the fee schedule. When covered, it is paid under reasonable charge procedures instead. See status indicators
Payer-specific coverage and documentation rules live outside these files, so a claim that clears every check here can still be denied on other grounds.
CMS RVU24BApril 1 – June 30, 2024
Can you bill it with another code? Copy link
Source & method Copy link
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01 PPRRVU24_APR.csv · Q2 2024 (RVU24B) · row 3,653—status E, RVUs limits
- Effective
- April 1 – June 30, 2024
- Locator
- PPRRVU24_APR.csv in rvu24b-updated-03-18-2024.zip · row 3,653 of 18,534 · via CMS
- Fields read
-
Status E (col 4)SHA-256 9acf98f4d515fb61…
- Doesn’t establish
- A locality-adjusted allowed amount, or the payment after sequestration. National baselines use GPCI 1.000 and exclude sequestration.
- Note
- Whether a national amount exists depends on the status and CMS’s payment instructions; blank RVUs are never treated as zero.
Cite this rate
HCPCS J2781 National PFS baseline: No national PFS rate (Q2 2024; participating physician; whole service; GPCI 1.000; sequestration excluded). CMS RVU24B, PPRRVU24_APR.csv row 3,653. Localis. https://localishealth.com/hcpcs/J2781/2024/B
Past releases are never edited, so the citation stays checkable after CMS publishes a newer one. CMS owns the code description shown for HCPCS Level II codes. Methodology · Plain-text summary · JSON
How has it changed? Copy link
— Office (non-facility) and — Facility since Oct 1, 2023.
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Jan 1, 2024 – Mar 8, 2024 · Superseded revision
Q1 2024 rev 1
Revision 1, later corrected by CMS- Office
- —
- Facility
- —
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Oct 1, 2023 – present
Q4 2023
Still in effect · 13 releases at this rate- Office
- —
- Facility
- —
Q4 2023 Oct 1, 2023 – Dec 31, 2023 · Q1 2024 Mar 9, 2024 – Mar 31, 2024 · Q2 2024 Apr 1, 2024 – Jun 30, 2024 · Q3 2024 Jul 1, 2024 – Sep 30, 2024 · Q4 2024 Oct 1, 2024 – Dec 31, 2024 · Q1 2025 Jan 1, 2025 – Mar 31, 2025 · Q2 2025 Apr 1, 2025 – Jun 30, 2025 · Q3 2025 Jul 1, 2025 – Sep 30, 2025 · Q4 2025 Oct 1, 2025 – Dec 31, 2025 · Q1 2026 Jan 1, 2026 – Mar 31, 2026 · Q2 2026 Apr 1, 2026 – Jun 30, 2026 · Q3 2026 Jul 1, 2026 – Sep 30, 2026 · Q4 2026 Oct 1, 2026 – present
Earliest release in this history.
National baseline (GPCI 1.000), before sequestration.
When does this rate change?
CMS publishes a fee schedule release every quarter (January, April, July, October), and each is versioned here. See what changed each release, or get an email when a new release moves rates.
Sources: CMS Medicare Physician Fee Schedule Relative Value Files.
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